It’s been a fruitful and inspiring year, with so much great new improvement content that it’s a challenge to choose “only ten” items to highlight at year’s end. But here, in no particular order, are some selections that we think are especially noteworthy. Revisit your favorites (or dig in for the first time, if you missed them before), share them with your colleagues, and use them to help kick-start your improvement efforts in the new year. From all of us at IHI, we wish you health and happy holidays. Enjoy!
New Rules for Redesigning Health Care
For leaders working hard to steer their organizations toward better care and lower costs, it helps to share ideas with one another about promising strategies and solutions. That’s why members of the IHI Leadership Alliance developed ten “new rules” to guide the radical redesign of health care delivery as we know it. Which rules resonate the most for you? Which ones would you like to focus on in your organization in 2016? Read about the guiding principles and the thinking behind them in articles in JAMA and Healthcare Executive, and watch the video of Alliance members talking about their favorite new rules.
Pursuing the Triple Aim
The Triple Aim has inspired and guided improvement in many countries, and here in the US it’s integral to the health care reform sought through the Affordable Care Act. “Pursuing the Triple Aim: The First Seven Years,” published in The Milbank Quarterly, draws on IHI’s seven years of successfully guiding organizations and communities working on the Triple Aim. The authors describe three underlying principles that made all the difference. As of November 2015, the Triple Aim article was Milbank’s most-downloaded article for the third month in a row, just one indication of how eager teams are to gain from each other’s experiences.
Addressing Diagnostic Errors in the US
In September 2015, the Institute of Medicine pulled no punches with its much-anticipated report on the nature and extent of diagnostic errors in the US. One in 20 of us are impacted each year by an incorrect diagnosis, a delayed one, or a test result that’s never communicated. Two of the report’s authors joined WIHI to break it all down and to underscore the safety improvements that need to be widely adopted. Two other reports published in 2015, from the National Patient Safety Foundation and The Health Foundation, broaden the context for the work that’s been accomplished and what still needs to be done to create safer health care in the US and the UK.
A Practical Guide for Designing and Executing Large-Scale Improvement Initiatives
After seven years of rapidly and successfully scaling up high-impact maternal and child health interventions across Ghana using a quality improvement approach, Project Fives Alive! has achieved remarkable results: a 31 percent reduction in under-5 mortality in 134 hospitals; a 37 percent reduction in post-neonatal infant mortality; and a 35 percent reduction in under-5 malaria case fatality. The publication, Lessons Learned from Ghana's Project Fives Alive! A Practical Guide for Designing and Executing Large-Scale Improvement Initiatives, harvests lessons from this work about project design, building quality improvement capability, managing complex partner relationships, providing effective leadership, and more.
The Employer-Led Health Care Revolution
When Intel started working with Virginia Mason Medical Center (VMMC), some amazing things happened. Intel’s leaders weren’t happy with rising health care costs and VMMC was in a position to do something about that. It’s a powerful story that was captured in the Harvard Business Review article, “The Employer-Led Health Care Revolution,” co-authored by IHI Executive Director of Innovation, Lindsay Martin. Lean improvement methods and continuous quality improvement were successfully put to the test like never before in an unprecedented collaborative, the model for which is very much worth studying. IHI continues to engage in research on employer-driven redesign of health care.
How to Talk about Dying
In her continuing efforts to encourage conversations about end-of-life care, Ellen Goodman’s New York Times op-ed, “How to Talk about Dying,” is another compelling rendering of how Ellen’s experiences gave rise to The Conversation Project. “The difference between a good death and a hard death often seemed to hinge essentially on whether someone's wishes were expressed and respected,” she says. While The Conversation Project is a public engagement campaign to transform the culture surrounding end-of-life care, IHI's "Conversation Ready" work focuses on ensuring that health care organizations have systems in place to receive patients’ wishes, to record them in the health record, and to respect them by providing care aligned with patients’ stated wishes.
Owning the Equity Challenge in Health Care
Researchers have been documenting and discussing health and health care disparities in the US for years. Improvers are now calling for a shift to demonstrating (and writing about) promising solutions. In a post to the IHI Blog, Dr. Patrick Courneya describes Kaiser Permanente’s work to reduce disparities that has generated some promising results. A post to the Health Affairs Blog, “Moving from Documenting Disparities to Reducing Them,” stems from an IHI session at the 2015 AcademyHealth panel on Disparities, Diversity, and Inclusion. We invite you to partake of the IHI Open School online course TA 102: Improving Health Equity, which is freely accessible during the month of January 2016.
Reducing C-Sections in Brazil
Brazil’s high C-section rate often garners media attention. In 2015 the issue got the attention of The Economist. “Caesar’s Legions” delves into the rise of Cesarean sections (C-sections) around the world, including Brazil, where in 2009, the C-section rate was 57 percent (with estimates that in Brazil’s private health system, the rate exceeds 90 percent). There are new efforts to reverse this trend. The Economist noted the collaboration between IHI and Albert Einstein Hospital in São Paulo (an IHI Strategic Partner) to increase Einstein’s rate of vaginal births. And, in a recent IHI Blog post, Dr. Paulo Borem, IHI Improvement Faculty in Brazil, talks more about the work he and his team undertook to reduce medically unnecessary C-sections at Unimed Jaboticabal in São Paulo.
Build Your Improvement Skills, One Video at a Time
Want to expand your improvement skills, but struggle to find the time to devote to this learning? The growing IHI Open School video library is one way to learn from health care leaders and experts from around the world as they share bite-sized pearls of knowledge and advice. Whether you make a meal or just enjoy the occasional snack, these freely available, short videos (most are 3 to 5 minutes) will whet your appetite for skill-building in the new year. Two popular recommendations for getting started are “How Can CLABSIs and Cucumbers Teach PDSA?” and “What’s the Secret to Running Effective Meetings?"
Why Health Care Improvement?
And finally, as we look back on all the challenges and successes we experienced in this past year, it may be helpful to reflect on why we do what we do — why health care improvement is both a personal and collective mission. Maureen Bisognano, IHI’s outgoing President and CEO, does just that in this short video explaining why she has devoted her career to improving health and health care, and how she learned the importance of asking, “What matters to you?"
What’s your favorite improvement content from 2015? What has been the most impactful resource for your improvement efforts? Share your thoughts in the User Comments section below.